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Please print or type. .r l� D � Y Form Approved, OMB No. 2050.0039 UNIFORM HAZARDOUS 1 • Generator ID Number 21. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAD981456023 2 800-633-8253 1000247425 DAT 5. Generator's Name and Mailing Address ATTN : Mike Ubick Generator's Site Address (if different than mailing address) Unhersity Of The Pacific University Of The Pacific 3601 Pacific Ave 3601 Pacific Ave , Stockton , CA 95211 Stockton , CA95211 Generators Phone: 209-946-2908 6. Transporter 1 Company Name U.S. EPA ID Number Ingenium (Sacramento)(** * * ERI PHONE-Gust ID# 8766-0004** * * CAR000179747 7. Transporter 2 Company Name U .S. EPA ID Number Ingenium ( Milpitas )(*' * * ERI PHONE-Gust ID# 8766-0002* ** *) CAR000179747 8, Designated Facility Name and Site Address U.S. EPA Io Number Recicladora Temai ryde Mexico , SAde CV MXC130610001 Carr. Fed . No . 2, Mex-Tij , KM 121 San Pablo Tecate, BC , Mexico , CP21530 Facility's Phone: 619-270-9453 Chemtrec 2411 # EMERGENCY (800) 424-9300 ga 9b. U .S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12, Unit HM and Packing Group (if any)) No. Type Quantity Wt.Nol, 13. Waste Codes 0 1 ' UN1993 , Waste Flammable liquids , n .o . s•. (ethanol , toluene) , 3 , II D001 F003 005 X DOT ERG# 128 © 100 6 331 2' NA3077 , Hazardous waste , solid , n .o .s . (lead nitrate , methanol) , 9 , D006 D007 D008 X III DOT ERG# 171 ' 00 0100 F003 F005 352 3. 4. 14. Special Handling Instructions and Additional Information D90971 SO 169203 1 ) R18 -21060 2) R18-21062 (gyCgS) f� � Primary ExporteffemarryRecycling ,lnc. AOC Solvent 020514 E18001 Aqueous 020526 E18001 Solid 020530 E1800 15. GENERATO 'SIO FEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are hilly and accurately described above by the proper shipping name, and are cl,nssified; packaged, marked and labeled/placarded , and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantU generator) is true. Generators/Offerors Printedrr d Name Si Month Day Year T 64L [ bm&s L 1:1� m 10) U 04a 16. Inti5mational Shipments Q1 4 ❑ Import to U .S. Export from U.S. Port of entry/exit: 2606 ? Transporter signature (for exports only): Date leaving U .S. : W 17. Transporter Acknowledgment of Receipt of Materials Transportet 1 Printed/Typed Name Signature Month Day Year a / o / Z Transporter 2 Printedffyped Name Signature Month Day Year r F- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quanti ❑ Type ❑ Residue ty ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Aitemale Facility (or Generator) U.S. EPA ID Number J U LL Facility's Phone: H18c. Signature of Alternate Facility (or Generator) Month Day Year a , Z N19. Hazardous Waste Report Management Method Codes (i.e. , codes for hazardous waste treatment, disposal, and recycling systems) 1 . 2, 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PdnledlTyped Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete . DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM